Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions

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Abstract
Background: This study examined the natural course of patients following surgery for small bowel obstruction (SBO) caused by abdominal adhesions. In addition, a cost analysis was performed. Methods: A retrospective analysis was undertaken of 102 patients who underwent surgery between 1987 and 1992 for intestinal obstruction due to abdominal adhesions. Results: Median follow-up was 14 years. The 102 patients experienced 273 episodes of intestinal obstruction after the index operation, of which 237 involved inpatient readmissions; 47·3 per cent of the episodes resulted in further surgery. Single band adhesions were more common in patients with no previous abdominal surgery (P < 0·001). Some 52·0 per cent of the patients had undergone only one operation for SBO. A mean of 2·7 episodes per patient occurred after the index operation. The cost of adhesion-related problems in this study was €1 588 594 or €6702 per inpatient episode. Conclusion: The readmission rate in a selected cohort of patients with proven intra-abdominal adhesions was higher than reported previously. The annual cost of adhesion-related problems in Sweden was estimated as €39·9–59·5 million, and the cost of inpatient readmissions was almost equal to that for gastric cancer.

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